<div id="content">

    <div id="content-header">

        <div id="breadcrumb"><a href="<?php echo site_url('Login/login') ?>" title="Go to Home" class="tip-bottom"><i
                class="icon-home"></i> 主页</a> <a href="#" class="current">客服工作台</a></div>

        <h1>代理账户注册</h1>

    </div>

    <div class="container-fluid">

        <hr>

        <div class="row-fluid">
            <div class="span8">
                <!--修改数据表单/edit news form-->
                <div class="widget-box">
                    <div class="widget-title"><span class="icon"> <i class="icon-align-justify"></i> </span>
                        <h5>注册信息</h5>
                    </div>
                    <div class="widget-content nopadding">
                        <form action="<?php echo site_url('customService/doCustomReg') ?>" method="post" class="form-horizontal">
                            <div class="control-group">
                                <label class="control-label">游戏类别:</label>
                                <div class="controls">
                                    <select name="gid" class="span6">
                                        <option value="0" selected='selected'>来来乐斗牛
                                        </option>
                                        <option value="1">广东转转麻将
                                        </option>
                                    </select>
                                </div>
                            </div>
                            <div class="control-group">
                                <label class="control-label">代理账号:</label>

                                <div class="controls">
                                    <input type="text" name='nickname' class="span6" placeholder="请输入账号" required="required">
                                </div>
                            </div>
                            <div class="control-group">
                                <label class="control-label">手机号:</label>

                                <div class="controls">
                                    <input type="text" name='phone' class="span6" placeholder="请输入手机号" required="required">
                                </div>
                            </div>
                            <div class="control-group">
                                <label class="control-label">密码:</label>

                                <div class="controls">
                                    <input type="text" name='pwd' class="span6" placeholder="请输入类别" required="required">
                                </div>
                            </div>
                            <div class="control-group">
                                <label class="control-label">重复密码:</label>

                                <div class="controls">
                                    <input type="text" name='pwd1' class="span6" placeholder="请输入密码" required="required">
                                </div>
                            </div>
                            <div class="control-group">
                                <label class="control-label">微信号:</label>

                                <div class="controls">
                                    <input type="text" name='wechat' class="span6" placeholder="请输入重复密码" required="required">
                                </div>
                            </div>
                            <div class="control-group">
                                <label class="control-label">真实姓名:</label>

                                <div class="controls">
                                    <input type="text" name='realname' class="span6" placeholder="请输入真实姓名" required="required">
                                </div>
                            </div>
                            <div class="control-group">
                                <label class="control-label">开户银行:</label>

                                <div class="controls">
                                    <input type="text" name='bankname' class="span6" placeholder="请输入开户银行" required="required">
                                </div>
                            </div>
                            <div class="control-group">
                                <label class="control-label">银行卡号:</label>

                                <div class="controls">
                                    <input type="text" name='bankcard' class="span6" placeholder="请输入银行卡号" required="required">
                                </div>
                            </div>
                            <div class="control-group">
                                <label class="control-label">区域信息:</label>

                                <div class="controls">
                                    <input type="text" name='address' class="span6" placeholder="请输入区域信息" required="required">
                                </div>
                            </div>

                            <div class="form-actions">
                                <button type="submit" class="btn btn-success">保存</button>
                            </div>
                        </form>
                    </div>
                </div>

                <!--修改数据表单/edit news form-->
            </div>
        </div>

    </div>

</div>